Normal Renal Function Patients Research Articles

Translated article] Influence of augmented renal clearance in the lower incidence of linezolid-related haematological toxicity

ObjectivesLinezolid is an oxazolidin commonly related to the development of haematological toxicity, being renal clearance the major factor involved in the drug clearance. The aim of this study is to evaluate the influence of increased filtration rates in the incidence of linezolid-induced haematological toxicity by comparing augmented renal clearance (ARC) patients versus normal renal function patients. Material and methodsA retrospective, observational study was conducted on hospitalized patients treated with linezolid for 5 days or more during 2014–2019 period. Patients with a filtration rate of ≥130 mL/min versus reference patients (60–90 mL/min) were compared. Haematological toxicity was defined as a decrease of 25% in platelets, of 25% in haemoglobin, and/or 50% in neutrophils from baseline. Toxicity relevance was classified according to Common Terminology Criteria for Adverse Events v5. Incidence of haematological toxicity between groups was studied by chi-square and Fisher test. Furthermore, percentage diminution of all 3 parameters was calculated and compared by Mann–Whitney test and treatment interruption and transfusion requirements were registered. Results30 ARC patients and 38 reference patients were included. Haematological toxicity was observed in 16.66% of ARC patients vs 44.74% of reference patients (P=.014); thrombocytopenia in 13.33% vs 36.84% (P=.051), anaemia in 3.3% vs 10.52% (P=.374) and neutropenia in 10% vs 23.68% (P=.204). Median percentage of platelets decrease in ARC patients was −10.36 (−193.33–62.03) vs 2.68 (−163.16–82.71) in reference patients (P=.333), while haemoglobin decrease was 2.50 (−12.12–25.93) vs 9.09 (−17.72–30.63) (P=.047) and neutrophils decrease was 9.14 (−73.91–76.47) vs 27.33 (−86.66–90.90) (P=.093). 10.5% of normal renal function patients reported at least 1 adverse event grade 3 or superior while 2.6% of them interrupted treatment and 5.2% had transfusion requirements. No major events or interruptions were reported in ARC patients. ConclusionOur findings suggest a lower incidence and clinical relevance of haematological toxicity in augmented renal clearance patients. Thrombocytopenia was the major event in both populations. This might be related to a lower exposure to the drug due to the higher clearance and likely lower therapeutic efficiency. These results suggest a potential benefit of therapeutic drug monitoring on high risk patients.

Influencia de la hiperfiltración glomerular en la menor toxicidad hematológica inducida por linezolid

ObjectivesLinezolid is an oxazolidin commonly related to the development of hematological toxicity, being renal clearance the major factor involved in the drug clearance. The aim of this study is to evaluate the influence of increased filtration rates in the incidence of linezolid-induced hematological toxicity by comparing augmented renal clearance (ARC) patients versus normal renal function patients. Material and methodsA retrospective, observational study was conducted on hospitalized patients treated with linezolid for 5 days or more during 2014–2019 period. Patients with a filtration rate of ≥130 mL/min versus reference patients (60–90 mL/min) were compared. Hematological toxicity was defined as a decrease of 25% in platelets, of 25% in hemoglobin and/or 50% in neutrophils from baseline. Toxicity relevance was classified according to Common Terminology Criteria for Adverse Events v5. Incidence of hematological toxicity between groups was studied by chi-square and Fisher test. Furthermore, percentaje disminution of all three parameters was calculated and compared by Mann–Whitney test and treatment interruption and tranfusion requirements were registered. Results30 ARC patients and 38 reference patients were included. Hematological toxicity was observed in 16.66% of ARC patients vs 44.74% of reference patients (p = 0.014); thrombocytopenia in 13.33% vs 36.84% (p = 0.051), anemia in 3.3% vs 10.52% (p = 0.374) and neutropenia in 10% vs 23.68% (p = 0.204). Median percentaje of platelets decrease in ARC patients was −10.36 (−193.33–62.03) vs 2.68 (−163.16–82.71) in reference patients (p = 0.333), while hemoglobin decrease was 2.50 (−12.12–25.93) vs 9.09 (−17.72–30.63) (p = 0.047) and neutrophils decrease was 9.14 (−73.91–76.47) vs 27.33 (−86.66–90.90) (p = 0.093). 10.5% of normal renal function patients reported at least one adverse event grade 3 or superior while 2.6% of them interrupted treatment and 5.2% had tranfusion requirements. No major events or interruptions were reported in ARC patients. ConclusionOur findings suggest a lower incidence and clinical relevance of hematological toxicity in augmented renal clearance patients. Thrombocytopenia was the major event in both populations. This might be related to a lower exposure to the drug due to the higher clearance and likely lower therapeutic efficiency. These results suggest a potential benefit of therapeutic drug monitoring on high risk patients.

The effects of renal impairment on the mid-term clinical outcomes following endovascular intervention for peripheral arterial disease

Peripheral arterial disease (PAD) shares common risk factors with coronary artery disease. Presence of renal impairment might affect the clinical outcomes of PAD patients, possibly due to vascular calcification. Treating calcified peripheral vessels is difficult and rate of re-narrowing and the need for re-intervention is generally higher compared to normal renal function patients.

Blood pressure variability and early neurological deterioration according to the chronic kidney disease risk categories in minor ischemic stroke patients.

Chronic kidney disease (CKD) increases blood pressure variability (BPV) and affects stroke outcomes. However, the effect of BPV on early neurological deterioration (END) may be different according to the renal function. We enrolled ischemic stroke patients with a National Institutes of Health Stroke Scale of ≤5. END was defined as worsening of ≥1 point in motor power or ≥2 points in total score. BPV was calculated with BP measured during the first 5 days and presented as standard deviation (SD) and coefficient of variation (CoV). Renal function was classified using the Kidney Disease Improving Global Outcomes (KDIGO) classification of CKD. Variables were compared between those with (KDIGO classification: moderate- to very-high-risk) and without renal impairment (KDIGO classification: low-risk) and factors associated with END were investigated. Among the 290 patients (136 [46.9%] renal impairment), END was observed in 59 (20.3%) patients. BPV parameters and the risk of END increased as renal function was impaired. Renal function and systolic BP (SBP) mean, SD, CoV, and diastolic BP (DBP) mean, SD were independently associated with END. We found no association between BPV parameters and END in normal renal function patients; however, among impaired renal function patients, SBP SD (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.09-1.32, P<0.001) and CoV (1.30 [1.12-1.50], P<0.001) were associated with END. The association between END and BPV parameters differs according to renal function in minor ischemic stroke; BPV was associated with END in patients with renal impairment, but less in those with normal renal function.

Outcomes of cardiac surgery in patients with end-stage renal disease: Insights from the Israel national registries.

End-stage renal disease (ESRD) has been shown to be associated with increased mortality in patients undergoing cardiac surgery. We aimed to compare the short- and mid-term mortality after cardiac surgery of patients with dialysis-dependent ESRD (DD-ESRD) to patients with normal renal function (NRF), using national registries: the ESRD registry, the adult cardiac surgery registry (ACSR), and the National Mortality Registry. The study population comprised 8207 adult patients who underwent either isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), or CABG + valve-related procedure, between January 2017 and April 2019. Data were retrospectively extracted and reported to the ACSR by the department of medical records of each medical center. One hundred and four DD-ESRD patients (mean age 63.2 ± 8.8 years, 83.7% males) were compared with 8103 NRF patients (mean age 64.9 ± 9.8 years, 77.6% males). Median follow-up for the total cohort was of 32.0 months (IQR; 25.0, 40.0). In DD-ESRD compared to NRF patients, 30-day mortality was higher (14.4% vs. 2.3%, respectively, p = 0.0001) and 4-year survival was significantly lower (44% ± 0.06 vs. 91% ± 0.04, respectively, p = 0.0001). Fifty-three percent of DD-ESRD 30-day mortality was caused by sepsis. Risk factors associated with reduced midterm survival included: DD-ESRD patients (HR = 4.7, 95% CI; 1.2-18.2), MVR procedure (HR = 1.5, 95% CI; 1.04-2.1) and combined CABG + valve-related procedure (HR = 1.6, 95% CI; 1.2-2.04). Preoperative DD-ESRD was associated with a significant increase in 30-day and mid-term mortality after cardiac surgery. The highest mortality rate was observed in valvular and combined procedures.

Renal Surgery and Postoperative AKI Risk in Normal Renal Function Patients: A Hidden Threat

Renal Surgery and Postoperative AKI Risk in Normal Renal Function Patients: A Hidden Threat

Renal Function Outcomes at 5 Years from Radical and Partial Nephrectomies in Normal Renal Function Patients: An Insidious Tale of Failed Renal Hyperfiltrations

Renal Function Outcomes at 5 Years from Radical and Partial Nephrectomies in Normal Renal Function Patients: An Insidious Tale of Failed Renal Hyperfiltrations

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan.

BackgroundLow trough concentrations of vancomycin (VCM) are common in patients receiving the drug, because patients are often administered relatively low doses of VCM due to its high potential for renal toxicity. However, the clinical risk factors associated with low VCM trough concentration in relation to renal function are unclear.MethodsPatients at our hospital who received VCM intravenously from January 2018 to December 2020 were analyzed. The patients were divided into two groups based on their renal function: normal and lower renal function, such as estimated glomerular filtration rate (eGFR) ≧60 and <60 mL/min/1.73 m2, respectively. In each renal function group, patients’ background characteristics, laboratory data and treatments were compared between lower VCM concentration (<10 mg/L) and appropriate VCM concentration (10–20 mg/L) subgroups.ResultsAmong 101 patients with normal renal function, 47 and 54 patients, respectively, showed lower and appropriate VCM trough concentrations. Elderly age, short stature, and higher C-reactive protein (CRP) level were significantly more common in the lower VCM concentration group compared with appropriate VCM concentration group. Among the 45 patients with renal dysfunction, 20 and 25 patients, respectively, showed lower and appropriate VCM trough concentrations. CRP levels were significantly higher in lower VCM concentration than appropriate VCM concentration subgroups. Multivariate analysis showed that insufficient total VCM doses and higher CRP might have affected the lower VCM trough concentration in patients with normal renal function.ConclusionThe results of this study suggest that higher CRP might be one of the risk factors associated with lower VCM concentration in both normal and low renal function patients. Severely ill and emergency patients might receive a lower VCM dose due to underestimation of the acceptable VCM dose.

Unexpected Outcomes of Renal Function after Radical Nephrectomy: Histology Relevance along with Clinical Aspects.

Acute kidney injury (AKI) and chronic kidney disease (CKD) are common events after radical nephrectomy (RN). In this study we aimed to predict AKI and CKD after RN relying on specific histological aspects. We collected data from a cohort of 144 patients who underwent radical nephrectomy. A histopathological review of the healthy part of the removed kidney was performed using an established chronicity score (CS). Logistic regression analyses were performed to predict AKI after RN, while linear regression analysis was adopted for estimated glomerular filtration rate (eGFR) variation at 1 year. The outcomes of the study were to determine variables correlated with AKI onset, and with eGFR decay at 1 year. The proportion of AKI was 64%. Logistic analyses showed that baseline eGFR independently predicted AKI (odds ratio 1.04, 95%CI 1.02:1.06). Moreover, AKI (Beta −16, 95%CI −21:−11), baseline eGFR (Beta −0.42, 95%CI −0.52:−0.33), and the presence of arterial narrowing (Beta 10, 95%CI 4:15) were independently associated with eGFR decline. Our findings showed that AKI onset and eGFR decline were more likely to occur with higher baseline eGFR and lower CS, highlighting that RN in normal renal function patients represents a more traumatic event than its CKD counterpart.

MO425RENAL SURGERY APPROACHES AND POST-OPERATIVE AKI DEVELOPMENT IN NORMAL RENAL FUNCTION PATIENTS; AN HIDDEN TREATH

Abstract Background and Aims Acute kidney injury (AKI) is a major postoperative complication in renal surgery for cancer, both in radical than in partial nephrectomy. One of the most intriguing arguments is to understand if normal renal function patients without renal urinary abnormalities can develop post-operative AKI after renal surgery. Aim of our study was to compare the AKI incidence in the two major renal surgeries approaches (radical and partial nephrectomies) in a selected cohort of patients with normal renal function. Method We performed a retrospective study of 216 patients who underwent radical (RN) or partial nephrectomy (PN) due to the presence of a kidney mass from 2000-2020 in a tertiary care Institution. Inclusion criteria: 1) Age&amp;gt; 18; 2) eGFR &amp;gt;;80 ml/min/1,73 using CKD-EPI formula 2012 3) absence of urinary abnormalities 4) presence of two kidneys at time operation. The following data were considered: age, gender, body mass index (BMI), TNM staging, hypertension, diabetes. Serum creatinine values were collected before surgery (t 0), at 48 hours after surgery and at dismissal. GFR was estimated at each time point using creatinine-based estimated glomerular filtration rate (eGFR) formula: CKD-EPI. We evaluated eGFR variation from the pre-surgical value to 48 h post and at dismissal. eGFR categories were created according to the KDIGO guidelines for G categories. Comparisons between groups were performed using Kruskal-Wallis ranks sum test for numerical variables and Pearson’s Chi square test for categorical variables. Logistic regression was used to identify variables ODDS Ratio for AKI onset after surgery. Results Clinical and pathological characteristics are reported in table 1. The cohort was composed by 216 patients with median Age 55 (IQR: 47, 64), M/F ratio 2.4, median BMI 25.8 (IQR: 23.3, 28.4), median eGFR 94.3 (IQR: 89.1, 101.6). According to CKD G classes, 79% were stage 1 and 2 1 were stage 2. The cohort was divided in two groups according to the type of surgery: 51% as RN and 49% as PN. Differences between the two groups were detected for Gender (Radical M/F ratio: 3.3; Partial M/F ratio: 1.8; p=0.4), basal eGFR (Radical Median:92.9 (88.1, 101.0); Partial Median:95.3 (90.7, 102.4); p=0.03) and CKD G class (Radical I:64%, II:36%; Partial I:78%, II:22%; p=0.02). Logistic regression for AKI onset showed as significant parameter (p&amp;lt;0.001) only the type of surgery observing for Radical Nephrectomy and ODDS Ratio of 4.6 (Confidence Interval: 2.6,8.5). The proportions of patients who developed AKI were 21% for PN and 55% for RN (Figure 1). Conclusion Our study highlights that both radical (55%) than partial (21%) nephrectomies harbor a non-negligible risk of post-operative AKI even in normal renal function patients without renal abnormalities. In addition, the impact of RN in normal renal function patients shows a dramatic incidence of AKI in the 50% of cases, suggesting that nephron sparing surgeries techniques should be always indicated to preserve renal function also in patients with an eGFR&amp;gt; 80 ml/min/1,73. A prospective comparison multicentric study with kidney living donor is on going.

MO532WHICH UNHEALTHY LIFE-BEHAVIOR IS THE MOST IMPACT FOR THE PRESENCE OF PROTEINURIA?

Abstract Background and Aims Unhealthy life-behaviors such as dietary habits, lack of exercise, drinking large amount of alcohol and smoking cause obesity, hypertension, diabetes, dyslipidemia, cardiovascular disease (CVD). These are also closely associated with chronic kidney disease (CKD). CKD is characterized by proteinuria and low glomerular filtration rate (GFR). Independent of GFR, proteinuria is an important predictor of ESKD. Few studies have assessed which is the most clinical impact among the unhealthy life-behaviors: skipping breakfast, snacking, late-night dinner, smoking, heavy alcohol intake and lack of exercise habits for proteinuria in normal renal function patients. Method This cross-sectional study included 29,780 normal renal function patients: eGFR≥60 mL/min/1.73 m2 and no history of kidney diseases who underwent health checkup at the Physical Checkup Center of Sumitomo Hospital. The endpoint of this investigation is defined as dipstick proteinuria of≥ 1+. To assess the association of life-behaviors and the presence of proteinuria, their odds ratios were calculated in adjusted univariable and multivariable logistic regression model. Multivariable logistic regression model was performed by not selected items, the same with univariable model. We would like to investigate the most impact unhealthy life-behavior for the proteinuria. Results Among 29,780 total study subjects (male: 60.3%; mean age: 49±11 years), 1,118 (3.75%) subjects were shown as urinary protein above 1+. The presence of unhealthy dietary life-behaviors: skipping breakfast, snacking and late-night dinner was 5,293 (17.3%), 3,899 (13.1%) and 11,231 (37.7%), respectively. About sleeping duration, the population of &amp;lt;6 hours, 6-8 hours and &amp;gt;8 hours were 12,027 (40.4%), 17,236 (57.9%) and 517 (1.7%). The population of exercise habits: over 3 days/weeks, 1-2 days/weeks and none were 5,138 (17.3%), 9,375 (31.5%) and 15,237 (51.3%), suggesting half of them did not have exercise habits. About smoking habits, the population of current smoking, past smoking and never smoking were shown 6,445 (21.6%), 8,459 (28.4%) and 14,876 (50.0%). In addition, about alcohol amount per day, the population of over 60g, 40-60g, 20-40g and 0-20g were 1,840 (6.18%), 4,504 (15.1%), 6,727 (22.6%) and 16,709 (56.1%). To investigate the impact of life-behavior for proteinuria, we obtained odds ratio of adjusted multivariable logistic regression model. In multivariable regression, among the life-behavior: skipping breakfast, current smoking, alcohol amount (ethanol over 60 g/day), none of exercise habits and snacking were strongly associated with the prevalence of proteinuria (skipping breakfast, adjusted odds ratio 1.45 [1.26, 1.68]; current smoking, 1.35 [1.14, 1.59]; alcohol amount (ethanol over 60 g/day), 1.35 [1.08, 1.69]; none of exercise habits, 1.29 [1.07, 1.57]; snacking, 1.23 [1.04, 1.46]). In addition, among the history of medical history, diabetes mellitus, hypertension and dyslipidemia were significantly associated with the prevalence of proteinuria (diabetes mellitus, adjusted odds ratio 2.39 [1.93, 2.96]; hypertension, 1.83 [1.53, 2.17]; 1.22 [1.03, 1.45]). Conclusion Among the unhealthy life-behaviors, skipping breakfast is the most impact factor for the presence of proteinuria.

MO133RENAL FUNCTIONAL OUTCOMES AT 5 YEARS FROM RADICAL AND PARTIAL NEPRHECTOMIES IN NORMAL RENAL FUNCTION PATIENTS : AN UNTOLD STORY OF FAILED RENAL HYPERFILTRATIONS

Abstract Background and Aims Despite major advance in surgical techniques in the last decade, Chronic Kidney Disease (CKD) is still a major postoperative long-term complication in renal surgery for renal cancer, both in radical than in partial nephrectomy. However, it is still debatable if the renal hyperfiltration mechanism which happens after an acute loss of nephron mass could promote in oncological patients an effective vicariant process over time able to replace a new renal function comparable with the pre-operative one. Aim of our study was to compare the eGFR decay over time from pre-operative time surgery to 5 years follow up in the two major renal surgeries approaches (radical-RN- and partial nephrectomies- PN) in a selected cohort of patients with normal renal function at baseline. Method We performed a retrospective cohort-study of 271 consecutive patients who underwent radical (RN) or partial nephrectomy (PN) due to the presence of a kidney mass suspected of malignancy from 2000-2020 in a tertiary care urological Institution. Inclusion criteria were: 1) Age &amp;gt; 18 years old 2) eGFR &amp;gt; 80 ml/min/1,73 using CKD-EPI formula 2012 3) absence of urinary abnormalities . The following data were considered: age, gender, body mass index (BMI), TNM staging, hypertension, diabetes. Glomerular Filtration rate (GFR) was estimated at each time point using creatinine-based estimated glomerular filtration rate (eGFR) formula. We evaluated eGFR variation at the pre-surgical value, hospital dismissal, 6,12,24,36,48,60 months. eGFR categories were created according to the KDIGO guidelines for G categories in GFR setting different thresholds. Comparisons between groups were performed using Kruskal-Wallis ranks sum test for numerical variables and Pearson’s Chi square test for categorical variables. Logistic regression was used to identify variables ODDS Ratio for AKI onset after surgery. Results The study cohort was composed by 271 patients with median Age 56 (IQR: 48, 64), M/F ratio 2.3, median BMI 25.7 (IQR: 23.3, 28.3), median eGFR 94.3 (IQR: 89.1, 101.3) mL/min/1.73m^2. According to CKD G class, 70% were I and 30% were II. The cohort was divided in two groups according type of surgery: 44% as RN and 56% as PN. Differences between the two groups were detected for Gender (Radical M/F ratio: 3.2; Partial M/F ratio: 1.8; p=0.4), basal eGFR (Radical Median:92.3 (88.0, 99.8) mL/min/1.73m2; Partial Median:95.4 (90.1, 102.0) mL/min/1.73m2; p=0.01) and CKD G class (Radical I:64%, II:36%; Partial I:76%, II:24%; p=0.03). Two-way Anova for time variation of eGFR according other parameters, enlightened a significative difference for the type of surgery (p&amp;lt;0.001): in particular, the analysis showed the presence of a variation over time of the eGFR (p&amp;lt;0.001) that depends also on the surgery type (p&amp;lt;0.001). Post-hoc analysis showed the impact of the differences in term of eGFR decay at different time points: at 6 months the radical nephrectomy groups had a mean decay higher (p&amp;lt;0.001) by 19 mL/min/1.73m2.(13.2, 24.9), at 12 months (p&amp;lt;0.001) by 19.6 mL/min/1.73m2.(14.9, 24.3), at 24 months (p&amp;lt;0.001) by 18 mL/min/1.73m2.(11.9, 25.2), at 36 months (p&amp;lt;0.001) by 15.4 (9.4, 21.4), at 48 months (p&amp;lt;0.001) by 16,4 (10.4, 22.3) and at 60 months (p&amp;lt;0.001) by 15 (11.2, 18.7) mL/min/1.73m2 (Figure 1) Conclusion Our study highlights that both RN than PN harbor a non negligible risk of post-operative CKD events even in normal renal function patients without renal abnormalities at 5 years from the operations. However, RN patients display a different behavior in term of renal compensation in respect of PN. In fact, RN pts tend to replace the acute loss of function derived from the absence of the contralateral kidney with an increase of eGFR , whereas PN pts tend to remain stable over time without any effort of hyperfiltration. A prospective comparison multicentric study with kidney living donor is on going.

Colistimethate Sodium Dosing and Nephrotoxicity among in-Patients at Tertiary Care Hospital Karachi, Pakistan

Introduction: Colistimethate sodium (CMS) is a polymyxin group of antibiotics which were throw out for many years, due to their potential adverse reaction neurotoxicity and nephrotoxicity. The different guidelines were reported regarding CMS dosing some based on Creatinine clearance (CrCl) and some on weight and CrCl. There are many discrepancies in the prevalence of nephrotoxicity that has been reported which included various definitions of acute renal injury and many CMS doses used in a variety of literature. In EMA guideline they suggested the dose as 9 MIU which is equivalent to 300 mg of CBA given as a maintenance dose with normal renal function patients. In FDA standard dosing of CMS remains 5 mg/kg CBA per day used and also dose is dependent on patient weight. The aim of this study was to evaluate the dosing criteria of colistimethate sodium associated with nephrotoxicity.&#x0D; Methodology: A prospective observational study was conducted in private sector tertiary care hospital in Karachi, Pakistan, for duration of six months from July 2020 to December 2020. Sample size was comprised of 157 patients, calculated at 35% prevalence, 95% Confidence Interval and 7% margin of error. Patient included were ≥ 18 years of age, who have received intravenous CMS therapy for greater than 48 hours. Patients having an acute kidney injury or on dialysis (at start of therapy) were excluded. Loading dose and daily dose of CMS was calculated by using actual body weight and Creatinine clearance (CrCl). Cockcroft and Gault equation was used to estimate CrCl before and after the therapy. Nephrotoxicity was assessed by using the RIFLE criteria. SPSS-20 was used for frequency distribution and percentage calculation to show categorical variable.&#x0D; Results: Among 157 enrolled patients, 101 (64.3%) were male and 56(35.7%) were female (Table 1). Table 2. represents that 68(43.3%) patients were admitted in intensive care unit (ICU) and 89(56.7%) were in medicinal ward; 22.9% patients were in between the age range 60-70 years (Table 3). Among all patients 63(40.1%) patients were at risk of nephrotoxicity, 27(17.2%) patients were developing injury and 14(8.9%) patients were diagnosed to kidney failure and 53(33.8%) patients were found not to developed nephrotoxicity (Table 4). Table 5 exhibits that 48.4% of the patients were receiving dose of CMS using EMA guideline while 51.6% patients were receiving dose of CMS 2.5-5 mgCBA/kg/day according to FDA. Nephrotoxicity was high among FDA regimen (44.5%).&#x0D; Conclusion: It was concluded that CMS dosing criteria have a significant impact on nephrotoxicity. Close monitoring of renal function, particularly the first week of CMS therapy should be considered to evaluate the renal toxicity of CMS.

Predictive performance of reported vancomycin population pharmacokinetic model in patients with different renal function status, especially those with augmented renal clearance

BackgroundThere is a significant correlation between augmented renal clearance (ARC) and lower serum trough concentrations of vancomycin (VCM) during therapy. There is a need to evaluate the predictive performance of...

Prognostic Impact of Preoperative Renal Insufficiency on Metastasis-Free Survival after Radical Cystectomy.

Several studies founded that preoperative renal insufficiency is associated with a higher risk of upper tract urothelial carcinoma recurrence and mortality than normal renal function patients. However, previous studies were all retrospective; no study focused on urothelial carcinoma in the bladder and metastasis-free survival (MFS). Herein, we examined the prognostic impact of preoperative renal insufficiency on the oncologic outcomes of patients with urothelial carcinoma in the bladder after radical cystectomy. We used data from 262 patients prospectively collected from a radical cystectomy cohort between March 2016 and February 2021. The patients were divided into those with a preoperative glomerular filtration rate (GFR) of <60 mL/min/1.73 m2 (renal insufficiency; n=66) and those with a GFR ≥60 mL/min/1.73 m2 (control; n=196). We investigated MFS, cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves and Cox proportional hazard regression were used to estimate the prognostic impact of renal insufficiency. The mean MFS was significantly shorter in the renal insufficiency group than in the control group (36.58±3.09 months vs. 47.37±1.87 months); however, OS and CSS were not significantly different. T stage ≥3 (hazard ratio [HR]: 2.79), lymph node positivity (HR: 2.261), and renal insufficiency (HR: 2.04) were significant independent predictors of MFS. Preoperative renal insufficiency was an independent prognostic factor for worse MFS. Well-designed randomized clinical trials and translational studies are needed to clarify the mechanism of relationship between preoperative renal insufficiency and MFS.

Platelet activity with hemoglobin level in patients with hemodialysis: Prospective study.

Background:VerifyNow (VN; Accumetrics, San Diego, CA) P2Y12 reaction unit (PRU) has an inverse relation with hemoglobin level (Hb). Chronic kidney disease (CKD) is associated with low response to clopidogrel and low Hb. Our aim is to investigate the relation between PRU and Hb, and to assess whether Hb directly affects PRU or not in patients with CKD undergoing hemodialysis (HD).Methods:We analyzed the relation between PRU and Hb in 43 HD patients and compared it with a control group of 127 patients with normal renal function. Both groups underwent percutaneous coronary intervention for stable coronary artery disease. We also compared PRU between the 2 groups considering Hb as a confounding factor.Results:In the control group, Hb and PRU showed a significant inverse correlation (correlation coefficient r = −0.340; P < .001), but not in the HD group (correlation coefficient r = −0.099; P = .53). PRU was higher in the HD group than the control group after adjusting for the influence of Hb (299.2 [95% confidence interval: 278.4–316.7] vs 248.7 [95% confidence interval: 227.7–269.0]; P < .001), even after propensity score matching (299.2 [95% confidence interval: 278.4–316.7] vs 241.7 [95% confidence interval: 221.8–262.2]; P < .001).Conclusions:PRU was higher regardless of lower Hb in CKD on HD patients than normal renal function patients. Therefore, Hb was not crucial factor to decide PRU in CKD on HD patients in this study.

A Renal Function Based Trade-Off Analysis of Non-vitamin K Antagonist Oral Anticoagulants in Nonvalvular Atrial Fibrillation.

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) depend on some degree of renal excretion, and no head-to-head comparisons based on renal function is available. This study mainly investigated the trade-off property of NOACs in nonvalvular atrial fibrillation (NVAF) with varying degrees of renal function.Methods: A comprehensive search of Medline, Embase, Cochrane Library, and Clinical Trials.gov Website was performed for eligible randomized controlled trials (RCTs) that reported the efficacy and safety outcomes according to renal function of NOACs. Primary efficacy outcome was any Stroke or systemic embolism (S/SE). Major bleeding was considered as a primary safety outcome. Risk ratios (RRs) with their confidence intervals (CIs), the surface under the cumulative ranking curve (SUCRA), and trade-off analysis were conducted by renal function.Results: Finally, 5 phase III Clinical Trials (72961 NVAF patients) comparing NOACs with warfarin in NVAF patients were included. In terms of normal renal function, dabigatran-150 mg was ranked first for efficacy (SUCRA: 90.3), and edoxaban-30 mg was ranked first for safety (SUCRA: 93.3). Dabigatran-110 mg/150 mg, and apixaban-5 mg were regarded as the most effective and reasonably safe interventions in the trade-off analysis. Regarding mild renal impairment, edoxaban-60 mg was ranked first for efficacy (SUCRA: 97.8), and edoxaban-30 mg was ranked first for safety (SUCRA: 99.5). Edoxaban-60 mg and dabigatran-150 mg were accounted as the most effective and reasonably safe interventions. With regards to moderate renal impairment, dabigatran-150 mg was ranked first for efficacy (SUCRA: 95.1), and edoxaban-15 mg was ranked first for safety (SUCRA: 98.2). Apixaban-2.5 mg and Edoxaban-30 mg was considered as the reasonably effective and the safest interventions.Conclusions: Dabigatran-150 mg seems the most effective therapy in patients with normal renal function and moderate renal impairment, and edoxaban-60 mg in patients with mild renal impairment. Low dose edoxaban (15 and 30 mg) seems the safest intervention. Apixaban-2.5 mg and edoxaban-30 mg might be the best trade-off property in moderate renal insufficiency.HIGHLIGHTS Dabigatran-150 mg seems the most effective therapy for normal renal function and moderate renal impairment patients, edoxaban-60 mg for mild renal impairment patients.Low-dose edoxaban can be considered as a good choice in NVAF patients at high risk of bleeding.Apixaban-2.5 mg and edoxaban-30 mg might be the balanced option in NVAF patients with moderate renal insufficiency.STUDY REGISTRATION: PROSPERO Identifier, CRD42017054235.

Intestinal fatty acid–binding protein levels in patients with chronic renal failure

BackgroundIntestinal fatty acid–binding protein (I-FABP), a biomarker of enterocyte injury, has been reported to be a diagnostic marker of intestinal ischemia and a prognostic marker in critically ill patients. However, the kinetics of I-FABP in renal failure patients is unknown. We sought to identify I-FABP levels in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) on hemodialysis (HD) and to identify the manner in which the I-FABP levels change. Materials and methodsAdult patients who were admitted for elective cardiac surgery with either normal renal function (NRF), CKD, or ESKD on HD were enrolled. Serum I-FABP levels in NRF and CKD patients and in ESKD patients before and after HD were determined. ResultsA total of 124 patients were evaluated: 47 NRF, 53 CKD, and 24 ESKD. The I-FABP levels of the CKD patients and pre-HD ESKD patients were significantly higher than those of the NRF patients (P = 0.018 and P <0.001, respectively). I-FABP levels were significantly negatively correlated with the estimated glomerular filtration rate in NRF and CKD patients (Spearman's ρ = −0.313, P = 0.002). In addition, I-FABP levels in ESKD patients were significantly lower after HD than those before HD (P <0.001). ConclusionsI-FABP levels in CKD and pre-HD ESKD patients were significantly higher than those in NRF patients. In addition, I-FABP was significantly eliminated by HD in patients with ESKD. Clinicians and researchers should consider this aspect of I-FABP when using it as a diagnostic and prognostic marker in patients with renal insufficiency.

Calciphylaxis: Beyond CKD-MBD

IntroductionCalcific uraemic arteriolopathy (CUA), also called calciphylaxis, is a rare but potentially fatal vascular disorder that almost exclusively affects patients with chronic renal failure. The objective of this study was to analyse various risk factors for developing CUA and its subsequent clinical course according to the treatment received. Materials and methodsA retrospective study that included patients diagnosed with CUA from December 1999 to December 2015. Various risk factors, clinical course and treatment options were analysed. ResultsA total of 28 patients (53.6% females) with a mean age of 67.2±11.8 (38–88) years were included. At the time of diagnosis, 53.6% were on haemodialysis, 25% were kidney transplant patients and 21.4% had normal renal function. The use of steroids (100%, p=0.001) was the main risk factor in renal transplant patients. Skin lesions resolved in 60.7% (especially in those receiving multitargeted therapy). Patient survival at 12 months was 29% in transplant patients, 57% in haemodialysis patients and 100% in normal renal function patients (log-rank 6.88, p=0.032). Chronic renal failure (p=0.03) and hypoalbuminaemia (p=0.02) were the main risk factor for CUA mortality. ConclusionsAlthough the incidence of CUA remains low, CUA mortality is very high, Special attention to its occurrence in kidney transplant patients and “non-renal” CUA forms is required. Oral anticoagulants and steroids appear to be the main risk factors, CUA is a challenge; a registry of patients and determining standard therapy are required.

Epidemiological investigation of multiple myeloma in Jining City

Objective To analyze clinical data of newly diagnosed multiple myeloma (MM) in Jining City in 2015, and to provide the theoretical basis for the epidemiological study of MM. Methods From 1 January 2015 to 31 December 2015, 114 patients with newly diagnosed MM were selected as the subjects in Jining City. The data of research subjects were selected from Cancer Reporting System of Jining Disease Control and Prevention Center , hospital information system (HIS) of second-graded or above hospitals in Jining City, and Information System of Jining Medical Insurance Management Center . The incidence rate of MM, distribution of gender, age and region, MM clinical stages, types of M protein, primary symptoms, and clinical features associated with renal damage were observed in Jining City in 2015. Results ①In 2015, the incidence rate of MM in Jining City was 1.38/105. ②The male incidence rate of MM was 1.68/105, and that of female was 1.14/100 000. The incidence rate of MM between male and female was statistically significant(χ2=4.176, P=0.041). ③The median age of onset in male MM patients was (65.9 ±9.9) years old, and that of the females were (65.3± 9.8) years old. The difference between them was not statistically significant(t=0.334, P=0.584). ④The incidence of MM in rural areas was 2.24/105, and the incidence of MM in urban areas was 0.59/105. There was significant difference between them(χ2=41.007, P<0.001). ⑤There were 57 patients(50.0%, 57/114) with stage Ⅲ MM. The main type of M protein was immunoglobulin (Ig) G, accounting for 43.0% (49/114). ⑥The main primary symptoms of MM were bone pain (32.5%, 37/114) and fatigue (21.9%, 25/114) at the first visit.⑦There were significant differences in levels of hemoglobin (Hb), levels of β2- microglobulin (MG), serum Ca2+ concentration between normal renal function patients and abnormal renal function patients (χ2=4.154, P=0.042; χ2=14.233, P<0.001; χ2=4.600, P=0.032). Conclusions In 2015, the age of MM onset in Jining City was younger than that in Europe and America, and the incidence rate of MM in male was higher than that in female. The incidence rate of MM in rural areas was higher than that in urban areas. The clinical stage of MM patients is usually stage Ⅲ at the first visit. Hemoglobin, serum Ca2+ concentration and β2-MG are closely related to the impairment of renal function in patients with MM. Key words: Multiple myeloma; Epidemiology; Incidence